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Introduction Most children with chronic kidney disease can expect that a successful renal transplant is an achievable goal and will provide the best survival and quality of life. Although significant [...], Background There are no guidelines for the removal of a failed renal allograft, and its impact on subsequent dialysis and retransplantation has not yet been described. Methods We performed a 10-year review of allograft failure to study the factors that determined an outcome of transplant nephrectomy and choice of subsequent renal replacement therapy in children with or without nephrectomy. Results A total of 34 children developed graft failure over the 10-year study period, of whom 18 (53 %) required transplant nephrectomy. The median graft survival was 1.1 (range 0.2-10.6) versus 7.5 (1.5-15.0) years in the nephrectomy and non-nephrectomy groups, respectively (p=0.011). Children with graft failure within 1 year of transplantation were four-fold more likely to require transplant nephrectomy than those with graft failure after 1 year (p=0.04). Renal biopsy performed at [less than or equal to] 8 weeks prior to graft loss showed Banff grade II acute rejection in 13 of the 18 children who required subsequent nephrectomy versus three of the 13 children who did not need nephrectomy (p=0.01). Inflammation (fever, graft tenderness and raised C-reactive protein (CRP) in the 2 weeks preceding graft failure) was seen in 66 % of nephrectomized children, but not in any in the non-nephrectomy group (p=0.0003 for CRP between groups). Banff II rejection, an inflammatory response and the time post-transplantation significantly and independently predicted the outcome of nephrectomy (p=0.008, [R.sup.2] = 67 %). Human leukocyte antigen (HLA) antibody levels after graft failure were higher in the nephrectomy group (p=0.0003), but there was no difference between groups in terms of the presence or class of donor-specific antibodies. Of the children with graft failure, 82 % required dialysis (61 % hemodialysis) and 35 % have to date been successfully retransplanted. Conclusions Children with Banff II rejection, an inflammatory response and early graft loss are more likely to require transplant nephrectomy. Nephrectomy may be associated with higher circulating HLA antibody levels. Keywords Renalallograft failure * Transplantnephrectomy * Children * Donor-specific antibodies * Humanleukocyte antigen antibodies

Tests the possibility that the apparent difference in the role of interleukin (IL)-4 in transplant vasculopathy is related to the protocol differences rather than to the species being studied. Dependence of transplant vasculopathy in the mouse on IL-4 and mediation by IL-5 and eosinophils; Association of IL-4 with the absence of transplant vasculopathy and down-regulation of a Th1-type response in the rat and human systems.